Testicular cancer treatment

Cancer treatment is a multimodality treatment, i.e., surgery is combined with radiotherapy and antineoplastic chemotherapy. The latter treatment mode is used mainly for cancers which have disseminated. Different forms of cancer differ in their sensitivity to chemotherapy with antineoplastic agents. The most responsive include lymphomas, leukemias, choriocarcinoma and testicular carcinoma, while solid tumors such as colorectal, pancreatic and squamous cell bronchial carcinomas generally show a poor response. The clinical use of antineoplastic agents is characterized by the following principles. 

Bleomycin (BLM) was first isolated as a copper complex from a culture of Streptomyces verticillus. Since then numerous analogs have been prepared by modifying the conditions of fermentation. Bleomycins (114, bleomycin A2) are used clinically in combination cancer chemotherapy for the treatment of head and neck cancer, certain lymphomas, and testicular cancer (555). 

Etoposide is an effective anticancer drug used in the treatment of small-cell lung cancer, testicular cancer and lymphomas. It is a semi-synthetic modification of the natural lignan podophyllotoxin, and contains three acetal linkages. Can you identify them ... 

After over half a century of chemotherapy research, cancer remains one of the most difficult life-threatening diseases to treat, a consequence of factors that include limitations of animal models, tiunour diversity, drug resistance and the side effects of therapy. Although there have been successes, most notably in treatment of testicular cancer [1], chemotherapy can currently still offer only a modest increase in survival time in the majority of advanced disease cases [2], The incidence of cancer is increasing due to ageing populations in most countries, and it has been estimated that in 20 years time there will be 20 million new cancer patients worldwide each year [3]. An optimistic view, however, is that in the coming decades advances in prevention, detection and treatment will see cancer becoming considered not as a fatal but as a chronic disease [3]. 

In a classic case of serendipity, cisplatin (PLATINOL ), a key component of the combination therapy which revolutionised treatment of testicular cancer [ 1 ], was uncovered fortuitously in the 1960s during studies on the effect of an electric current on the growth of E. coli [ 17,18]. Cell division was inhibited not by the electric current but by production of a platinum complex from the... 

Therapeutic modalities in cancer treatment may involve surgery, radiation, and/or chemotherapy. The objectives of cancer chemotherapy include (1) cure, (2) reduction in tumor size, and (3) prolongation of life. At the present time, approximately 50 percent of patients with cancer can be cured, with drug treatment estimated to contribute in 17 percent of cases. Cancer chemotherapy can be curative in testicular cancer, diffuse large cell lymphoma, Hodgkin s disease, choriocarcinoma, certain childhood tumors (acute lymphoblastic leukemia, Burkitt s lymphoma, Wilms tumor, and embryonal rhabdomyosarcoma). Certain cancers are more resistant to chemotherapy than others (e.g., lung and colon). 

In this dismal history, can we find some clue as to a possible cause and treatment I believe so, since, as we have seen, we can already, in a small number of cancer types, achieve substantial cure rates. Testicular cancer, with a cure rate approaching 100%, is the prime example of this, and this is... 

The focus in good-risk patients was to decrease the toxicity of treatment. Substitution of cisplatin by carboplatin was attempted in two randomized trials [43] [44], In both, outcomes were worse in patients who received carboplatin. Thus, in testicular cancer standard dose carboplatin is not therapeutically equivalent to cisplatin. 

Compared to other solid tumors, ovarian cancer is relatively responsive to chemotherapy, but unlike testicular cancer, cure is not common for patients with advanced disease. Prior to the incorporation of cisplatin or carboplatin into treatment regimens, chemotherapy for advanced-stage ovarian cancer consisted of combinations of alkylating agents and doxorubicin. Response rates from such regimens were of the order of 33-65%, and fewer than 10% of patients survived 5 years [51]. 

Cisplatin is one of the most effective and broadly used anticancer drugs and it is particularly useful for the treatment of testicular cancer [1], Cisplatin interacts with cellular DNA, RNA and proteins [2-4], Interaction of cisplatin with DNA forms several classes of DNA adducts [3]. DNA adducts are generally considered to be responsible for the toxicity and mutagenicity of cisplatin, although its biological activity cannot be solely explained by its ability to damage DNA [4],... 

Gieterna JA, Meinardi MT, Messerschmidt J, et al. Circulating plasma platinum more than 10 years after cisplatin treatment for testicular cancer. Lancet, 2000, 355, 1075-1076. 

Some anti-cancer agents act by generating highly reactive hydroxyl radicals, which damage and degrade the DNA of the rapidly dividing tumor cells. As a result, the cells die and the tumor shrinks. One example of a radical generator is bleomycin, which is used for the treatment of testicular cancer. 

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